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      Presepsin as a diagnostic marker of sepsis in children and adolescents: a systemic review and meta-analysis

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          Abstract

          Background

          Early diagnosis of sepsis in pediatric patients is vital but remains a major challenge. Previous studies showed that presepsin is potentially a reliable diagnostic biomarker for sepsis in adult and neonates. However, there is no pooled analysis of its efficacy as a diagnostic biomarker for sepsis in children. The aims of the present meta-analysis were to assess the overall diagnostic accuracy of presepsin in pediatric sepsis and compare it to those for C-reactive protein (CRP) and procalcitonin (PCT).

          Methods

          A systematic literature search was performed in Medline/Pubmed, Embase, the Cochrane Library, and ISI Web of Science to identify relevant studies reporting the diagnostic accuracy of presepsin in patients with pediatric sepsis. Sensitivities and specificities were pooled by bivariate meta-analysis. Heterogeneity was evaluated by χ 2 test.

          Results

          We identified 129 studies in total. Most were disqualified on the basis of their titles/abstracts and duplication. Four studies were included in the final analysis. They comprised 308 patients aged between 1 mo and 18 y. The pooled diagnostic sensitivity and specificity of presepsin were 0.94 (95% confidence interval [CI]: 0.74–0.99) and 0.71 (95% CI: 0.35–0.92), respectively. The pooled diagnostic odds ratio, positive likelihood ratio (LR), and negative LR of presepsin were 32.87 (95% CI: 2.12–510.09), 3.24 (95% CI, 1.14–12.38), and 0.08 (95% CI, 0.01–0.74), respectively. Heterogeneity was found in both sensitivity (χ 2 = 11.17; P = 0.011) and specificity (χ 2 = 65.78; P < 0.001). No threshold effect was identified among the studies (r = − 0.938). The pooled sensitivity of presepsin (0.94) was higher than that of CRP (0.51) and PCT (0.76), whereas the overall specificity of presepsin (0.71) was lower than that of CRP (0.81) and PCT (0.76). The AUC of presepsin (0.925) was higher than that of CRP (0.715) and PCT (0.820).

          Conclusion

          Currently available evidence indicates that presepsin has higher sensitivity and diagnostic accuracy, but lower specificity, than PCT or CRP in detecting sepsis in children. However, these results must be carefully interpreted as the number of studies included was small and the studies were statistically heterogeneous.

          Electronic supplementary material

          The online version of this article (10.1186/s12879-019-4397-1) contains supplementary material, which is available to authorized users.

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          Most cited references38

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          Human C-reactive protein: expression, structure, and function

          Molecular Immunology, 38(2-3), 189-197
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            Procalcitonin as an early marker of infection in neonates and children.

            A child or neonate presenting with fever is a common medical problem. To differentiate between those with a severe bacterial infection and those with a localised bacterial or a viral infection can be a challenge. This review provides an overview of neonatal and paediatric studies that assess the use of procalcitonin as an early marker of bacterial infection. Procalcitonin is an excellent marker for severe, invasive bacterial infection in children. However, the use of procalcitonin in the diagnosis of neonatal bacterial infection is complicated, but if correctly used procalcitonin results in a higher specificity than C-reactive protein. In addition, procalcitonin has been shown to correlate with severity of disease (urinary tract infections and sepsis), and can therefore be used as a prognostic marker. Procalcitonin is therefore a useful additional tool for the diagnosis of bacterial disease in neonates and children.
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              Molecular diagnosis of sepsis: New aspects and recent developments

              By shortening the time to pathogen identification and allowing for detection of organisms missed by blood culture, new molecular methods may provide clinical benefits for the management of patients with sepsis. While a number of reviews on the diagnosis of sepsis have recently been published we here present up-to-date new developments including multiplex PCR, mass spectrometry and array techniques. We focus on those techniques that are commercially available and for which clinical studies have been performed and published.
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                Author and article information

                Contributors
                +82-2-2228-2057 , JGAHN@yuhs.ac
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                30 August 2019
                30 August 2019
                2019
                : 19
                : 760
                Affiliations
                [1 ]ISNI 0000 0004 0470 5454, GRID grid.15444.30, Department of Pediatrics, Severance Children’s Hospital, , Yonsei University College of Medicine, ; 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Korea
                [2 ]ISNI 0000 0004 0470 5454, GRID grid.15444.30, Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, , Yonsei University College of Medicine, ; Seoul, Korea
                Author information
                http://orcid.org/0000-0001-5748-0015
                Article
                4397
                10.1186/s12879-019-4397-1
                6717384
                31470804
                22bc4ce9-b5e6-42d2-acf4-ff26aaaa7cb6
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 June 2019
                : 23 August 2019
                Funding
                Funded by: Korean Society of Pediatric Infectious Diseases
                Award ID: none
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Infectious disease & Microbiology
                sepsis,presepsin,diagnosis,meta-analysis,child,sensitivity,specificit
                Infectious disease & Microbiology
                sepsis, presepsin, diagnosis, meta-analysis, child, sensitivity, specificit

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